Cutaneous Plasmacytosis Showing a Neuronal Involvement in a 35-Year-Old Female

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Brief Report

174 Ann Dermatol

Received January 23, 2019, Revised July 29, 2019, Accepted for publication July 31, 2019

Corresponding author: Myoung-Shin Kim, Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil- ro, Nowon-gu, Seoul 01757, Korea. Tel: 82-2-950-1131, Fax: 82-2- 931-8720, E-mail: [email protected]

ORCID: https://orcid.org/0000-0002-0660-8098

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.

org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

CONFLICTS OF INTEREST

The authors have nothing to disclose.

ORCID

YoungHwan Choi, https://orcid.org/0000-0003-4177-7724 Donghwi Jang, https://orcid.org/0000-0002-3495-4772 Hyun Jeong Byun, https://orcid.org/0000-0002-4354-5655 Se Jin Oh, https://orcid.org/0000-0001-7525-4740 Cho Rok Kim, https://orcid.org/0000-0003-4168-4245 Ji-Hye Park, https://orcid.org/0000-0002-6699-5202 Jong Hee Lee, https://orcid.org/0000-0001-8536-1179 Dong-Youn Lee, https://orcid.org/0000-0003-0765-9812

REFERENCES

1. Hong J, Bernstein D. A review of drugs that induce or exacerbate psoriasis. J Psoriasis Psoriatic Arthritis 2012;18:2-11.

2. Kurtulus S, Sakuishi K, Zhang H, Joller N, Tan D, Smyth M, et al. Mechanisms of TIGIT-driven immune suppression in cancer. J Immunother Cancer 2014;2(Suppl 3):O13.

3. Dixon KO, Schorer M, Nevin J, Etminan Y, Amoozgar Z, Kondo T, et al. Functional Anti-TIGIT antibodies regulate development of autoimmunity and antitumor immunity. J Immunol 2018;200:3000-3007.

4. Voudouri D, Nikolaou V, Laschos K, Charpidou A, Soupos N, Triantafyllopoulou I, et al. Anti-PD1/PDL1 induced psoriasis. Curr Probl Cancer 2017;41:407-412.

5. Wang FF, Wang Y, Wang L, Wang TS, Bai YP. TIGIT expression levels on CD4+ T cells are correlated with disease severity in patients with psoriasis. Clin Exp Dermatol 2018;

43:675-682.

https://doi.org/10.5021/ad.2020.32.2.174

Cutaneous Plasmacytosis Showing a Neuronal Involvement in a 35-Year-Old Female

Joong-Heon Suh, Ho-Young Kim, Jae Ho Lee, Soo-Kyung Lee, Un-Ha Lee, Myoung-Shin Kim

Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

Dear Editor:

Cutaneous plasmacytosis (CP) is a rare skin disorder char- acterized by multiple reddish-brown patches and nodules that mainly occur on the trunk in adults¹. Histologically, there is a dermal infiltrate of mature plasma cells. We re-

port a case of 35-year-old female who presented with multiple red to brownish macules and patches on the left side of the trunk with a neuronal distribution (Fig. 1). The lesion appeared 4 years ago without any symptoms of pain or itching. A histopathological examination revealed a dense dermal patch-like cellular infiltration surrounding the fol- licles and the nerves (Fig. 2). The infiltrate was composed of lymphocytes, histiocytes, and plasma cells. Immunohis- tochemical staining was positive for CD138, CD3, and CD20. Serum protein electrophoresis and immunoelectrophoresis revealed polyclonal hypergammaglobulinemia.

Based on these findings, a diagnosis of CP was made. The patient underwent treatment with systemic corticosteroids and narrowband ultraviolet B for 3 months till date. How- ever, the response to the treatment has been minimal.

In our review of the literature, skin manifestations of CP were considerably uniform among patients, with multiple reddish to brownish colored scaly patches, nodules, and

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Brief Report

Vol. 32, No. 2, 2020 175 Fig. 1. Multiple red to brownish maculopatches in the left side of the trunk showing a neuronal dermatosis. We received the patient’s consent form about publishing all photographic materials.

Fig. 2. (A) Lymphoid follicle-like nodular cell infiltrates in the middle and deep dermis intermingled with sparse interstitial cell infiltrates (H&E stain, ×40) (B) Nodules are composed of plasma cells without atypia. Plasma cells are surrounding the neuron (H&E stain, ×400;

inlet, ×400).

infiltrated plaques. Moreover, they were usually persistent, asymptomatic, or mildly pruritic and were mainly distributed on the chest or back in a symmetrical or “Christmas tree” like pattern, which may require precise differential diagnosis including pityriasis rosea and small patch para- psoriasis^1,2. Several other cases with facial or scalp involvement demonstrated a typical trunk involvement pattern as well². Interestingly, in our patient, the distribution of the lesion showed an atypical pattern, affecting only the left side of the body and showing neuronal pattern dermatoses.

The histopathologic findings characteristically show dermal nodular and perivascular/periadnexal cell infiltrations with predominance of plasma cells admixed with variable numbers of lymphocytes and histiocytes³. Recently, Honda et al.³ reported 6 cases of CP all showing the perineural

and intraneural distribution of plasma cells. Similarly, in our patient’s punch biopsy specimen, we observed perineural plasma cell infiltration. In this case, we hypothesize that the numerous plasma cells aggregated around the nerve fiber may have a correlation with the unilaterally neuronal pattern of the skin lesions. Furthermore, the typical symmetric pattern of CP on the chest or back may be a phenotypic expression reflecting its close relationship to the spinal nerve tract distribution.

Protein electrophoresis and immunoelectrophoresis gen- erally show polyclonal increase in the gamma globulin fraction in major portion (84%) of the CP patients². However, the direct relationship between polyclonality and etiology of CP is unclear. If monoclonality is observed, it is necessary to exclude the possibility of margin- al zone B cell lymphoma. Polymerase chain reaction for

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Brief Report

176 Ann Dermatol

Received March 18, 2019, Revised July 23, 2019, Accepted for publication August 7, 2019

Corresponding author: Sung-Ae Kim, Department of Dermatology, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea. Tel:

82-53-250-7624, Fax: 82-53-250-7626, E-mail: skksasf@ hanmail.net ORCID: https://orcid.org/0000-0002-6040-6630

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

immunoglobulin heavy chain gene rearrangement and B-cell lymphoma 2 staining would be helpful to make the diagnosis clear⁴.

In summary, a diagnosis of CP should be considered when dermatologists encounter cases of asymptomatic neuronal pigment dermatosis. We speculate that further investiga- tions on the association of the neural pathway with re- spect to the pathophysiology would be helpful to improve our understanding about CP.

CONFLICTS OF INTEREST

The authors have nothing to disclose.

ORCID

Joong-Heon Suh, https://orcid.org/0000-0002-1046-0487 Ho-Young Kim, https://orcid.org/0000-0002-1029-3287 Jae Ho Lee, https://orcid.org/0000-0002-3872-0527 Soo-Kyung Lee, https://orcid.org/0000-0002-7460-5657

Un-Ha Lee, https://orcid.org/0000-0003-1626-5583 Myoung-Shin Kim, https://orcid.org/0000-0002-0660-8098

REFERENCES

1. Uhara H, Saida T, Ikegawa S, Yamazaki Y, Mikoshiba H, Nijoh S, et al. Primary cutaneous plasmacytosis: report of three cases and review of the literature. Dermatology 1994;

189:251-255.

2. Haque M, Hou JS, Hisamichi K, Tamada K, Cusack CA, Abdelmalek M, et al. Cutaneous and systemic plasmacytosis vs. cutaneous plasmacytic castleman disease: review and speculations about pathogenesis. Clin Lymphoma Myeloma Leuk 2011;11:453-461.

3. Honda R, Cerroni L, Tanikawa A, Ebihara T, Amagai M, Ishiko A. Cutaneous plasmacytosis: report of 6 cases with or without systemic involvement. J Am Acad Dermatol 2013;68:978-985.

4. Han XD, Lee SSJ, Tan SH, Chong WS, Ng SK, Ooi MGM, et al. Cutaneous plasmacytosis: a clinicopathologic study of a series of cases and their treatment outcomes. Am J Dermatopathol 2018;40:36-42.

https://doi.org/10.5021/ad.2020.32.2.176

Expression of Human Herpes Virus 6, 7, Epstein-Barr Virus and Cytomegalovirus in Patients with Diverse Adverse Cutaneous Reactions to Drug

Young-Wook Ryoo, Joon-Bum Lee, Won-Oh Kim, Sung-Ae Kim

Department of Dermatology, Keimyung University School of Medicine, Daegu, Korea

Dear Editor:

Various drugs can cause diverse cutaneous adverse drug reactions (CADR)¹. Factors have been implicated in CADR, including the dosage, duration of use, physiological status

and genetic background of the patient¹. In addition, cur- rent or past viral infection has been reported to affect the occurrence of CADR². In particular, many authors have suggested the activation of human herpes virus (HHV) 6,